Diagnosis: CLL

Your Guide to Understanding How Chronic Lymphocytic Leukemia is Treated

Chronic lymphocytic leukemia is a type of cancer in which the bone marrow makes too many lympho­cytes (a type of white blood cell). CLL, a slow-growing blood and bone marrow disease, is one of the most common types of leukemia in adults.

If you’ve been diagnosed with CLL, you’re probably wondering about your options for treating the disease. Differ­ent types of treatment are available for people with CLL. Some treatments are standard (the currently used treatments), and some are being tested in clinical trials. Certain factors affect treatment, including the stage of the disease; red blood cell, white blood cell, and plate­let blood counts; presence of symptoms such as fever, chills, or weight loss; whether the liver, spleen, or lymph nodes are larger than normal; response to initial treatment; and whether the CLL has recurred.

Currently, five types of standard treatment are used for CLL: watchful waiting, radiation therapy, chemotherapy, surgery, and targeted therapy. Here is a breakdown of these treatments, as well as some information on a couple of treatments that are being tested in
clinical trials.

Five types of standard treatment are used for CLL.

Watchful waiting involves your doc­tor closely monitoring your condition without treating it until CLL symptoms appear or change. During this time, problems caused by the disease, such as infection, are treated.

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a ma­chine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or
catheters that are placed directly into
or near the cancer.

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the blood­stream and can reach cancer cells throughout the body (systemic chemo­therapy). When chemotherapy is placed directly into the cerebrospinal fluid,
an organ, or a body cavity such as
the abdomen, the drugs mainly affect cancer cells in those
areas (regional chemotherapy).

Surgery to remove the spleen
(splenectomy) can relieve the discom­fort of an enlarged spleen and, for some people, increase blood cell counts. However, surgery is not in­tended to cure the disease.

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Monoclonal antibody therapy uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances in the body that may help cancer cells grow. The antibodies attach to those substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or
to carry drugs, toxins, or radioactive material directly to cancer cells.

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Tyrosine kinase inhibitor therapy is a treatment that blocks signals needed for tumors to grow.

Clinical trials are research studies meant to help improve current treatments or obtain information on new treatments for people with cancer. When clinical trials show that a new treatment is bet­ter than the standard treatment, the new treatment may become the standard treatment. Even when clinical trials
do not lead to effective new treatments, they often answer important questions and help move research forward. The following are two CLL treatments that are being studied in clinical trials.

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Chemotherapy with stem cell
transplant is a method of giving chemo­therapy and then replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from your blood or bone
marrow, or from that of a donor, and are frozen and stored. After chemo­therapy is completed, the stored stem cells are thawed and infused into your body, where they can grow into (and restore) your blood cells.

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Biologic therapy (also called biotherapy or immunotherapy) uses your immune system to fight cancer. Substances made by your body or made in a laboratory are used to boost, direct, or restore your body’s natural defenses against cancer.

Follow-up tests may be needed throughout the course of your treatment. Some of the tests that were done to
diagnose or stage your cancer will
be repeated in order to see how well treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some tests will be done from time to time after treatment has ended. The results of these tests can show if your condition has changed
or if the cancer has recurred.

How Is CLL Diagnosed?

Tests that examine the blood, bone marrow, and lymph nodes are used to detect and diagnose chronic lymphocytic leukemia. The following tests and procedures may be performed: ♦
Physical exam and history A physical exam is done to check general signs of health and to detect signs of disease, such as lumps or anything else that seems unusual. A history of your health habits and past illnesses and treatments will also be examined.♦
Complete blood count with differential A sample of your blood is drawn and checked for the number of red blood cells and platelets; the number and type of white blood cells; the amount of hemoglobin (the protein that carries oxygen) in the red blood cells; and the portion of the blood sample made up of red blood cells.♦
Immunophenotyping In this laboratory test, the antigens or markers on the surface of a blood or bone marrow cell are checked to see if they are lymphocytes or myeloid cells. If the cells are malignant lymphocytes (cancer), they are checked to determine if they are B lymphocytes or T lymphocytes.♦
FISH (fluorescence in situ hybridization) FISH is a technique used to look at genes or chromosomes in cells and tissues. Pieces of DNA that contain a fluorescent dye are made in the laboratory and added to cells or tissues on a glass slide. When these pieces of DNA bind to specific genes or areas of chromosomes on the slide, they light up when viewed under a microscope with a special light. ♦
Flow cytometry The number of cells, the percentage of live cells, and certain characteristics of cells, such as size, shape, and the presence of tumor markers on the cell surface, are measured in a bone marrow or blood sample with this laboratory test. The cells are stained with a light-sensitive dye, placed in a fluid, and passed in a stream before a laser or other type of light. The measurements are based on how the light-sensitive dye reacts to the light.♦
IgVH gene mutation test This test is done on a bone marrow or blood sample to check for an IgVH gene mutation. People with an IgVH gene mutation have better prognoses.♦
Bone marrow aspiration and biopsy Bone marrow, blood, and a small piece of bone is removed with a hollow needle inserted into your hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells.

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If you’re interested in joining a clinical trial, visit cancer.gov/clinicaltrials to find one in your area.